Li Yan, Sun Lifang, Zheng Xiuli, Liu Jingfang, Zheng Rong, Lv Yanwei
Department of Obstetrics and Gynecology, Beijing Jishuitan Hospital, Beijing, China.
Clinical Epidemiology Research Office, Beijing Jishuitan Hospital, Beijing, China.
Ann Palliat Med. 2021 Jul;10(7):7619-7626. doi: 10.21037/apm-21-1244.
The aim of this study is to evaluate the association between platelet parameters and soluble vascular endothelial growth factor receptor-1 (sFlt-1)/placenta growth factor (PlGF) in preeclampsia (PE) and establish a prediction model by analyzing commonly used biochemical markers.
A nested case-control study involving 270 pregnant women in their second trimester from the Beijing Jishuitan Hospital was conducted. They were divided into PE group and control group. The levels of PlGF, sFlt-1, sFlt-1/PlGF, and platelet parameters were recorded and compared at 20-24 gestational weeks. The correlation between platelet parameters and PlGF, sFlt-1, and sFlt-1/PLGF was then analyzed. A receiver operating characteristic (ROC) curve was used to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various biomarkers in predicting PE.
In PE group, the levels of mean platelet volume (MPV), platelet distribution width (PDW), sFlt-1, and sFlt-1/PLGF were higher than in the control group, while the levels of platelet count (PC), PC/MPV, and PLGF in PE group were lower. Spearman correlation analysis showed that PC and PC/MPV were negatively correlated with sFlt-1 and sFlt-1/PLGF, and positively correlated with PLGF, while further analysis found that PC/MPV had the largest area under the ROC curve with sensitivity of 83.7% and specificity of 86.2%. The area under curve (AUC) of sFlt-1, PLGF, and sFlt-1/PLGF for predicting PE were 0.731, 0.772, and 0.825, respectively. Their AUCs could be improved to 0.820, 0.838, and 0.873 when combined with PC/MPV.
The accuracy of sFlt-1/PlGF in predicting the risk of PE in the second trimester is significantly improved when combined with PC/MPV, which is expected to be an ideal tool for PE prediction.
本研究旨在评估子痫前期（PE）患者血小板参数与可溶性血管内皮生长因子受体-1（sFlt-1）/胎盘生长因子（PlGF）之间的关联，并通过分析常用生化标志物建立预测模型。
对北京积水潭医院270例孕中期孕妇进行巢式病例对照研究。将她们分为PE组和对照组。记录并比较妊娠20 - 24周时PlGF、sFlt-1、sFlt-1/PlGF及血小板参数水平。然后分析血小板参数与PlGF、sFlt-1及sFlt-1/PlGF之间的相关性。采用受试者工作特征（ROC）曲线计算各生物标志物预测PE的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
PE组平均血小板体积（MPV）、血小板分布宽度（PDW）、sFlt-1及sFlt-1/PlGF水平高于对照组，而PE组血小板计数（PC）、PC/MPV及PlGF水平较低。Spearman相关性分析显示，PC和PC/MPV与sFlt-1及sFlt-1/PlGF呈负相关，与PlGF呈正相关，进一步分析发现PC/MPV的ROC曲线下面积最大，敏感性为83.7%，特异性为86.2%。sFlt-1、PlGF及sFlt-1/PlGF预测PE的曲线下面积（AUC）分别为0.731、0.772和0.825。与PC/MPV联合时，它们的AUC可分别提高到0.820、0.838和0.873。
sFlt-1/PlGF与PC/MPV联合时，预测孕中期PE风险的准确性显著提高，有望成为PE预测的理想工具。
